In September, many SmartBrief readers had their interest piqued by stories on serious health care challenges that require far-reaching solutions. They wanted to know what causes the US health care system to compare unfavorably with those of other nations, what’s behind the curtain on workforce shortages, how public health entities are responding to belt-tightening, what the future holds for US counties with no obstetric clinicians, and just how serious the fallout from these challenges may become.
How do world nations stack up on health care?
What happened: A report from The Commonwealth Fund found that the overall US health care system doesn’t compare well with those of other high-income nations. Of 10 countries studied, the US ranked last, based on indicators such as preventing deaths, accessing care and providing quality treatment for all people regardless of demographic factors. US residents die at the youngest age and have the highest level of avoidable death among the 10 nations.
That’s despite the fact that the US spends about 18% of its gross domestic product on health care – far more than the other ranked nations (Canada, France, Australia, New Zealand, the Netherlands, Germany, Sweden, Switzerland and the UK). Each was scored on five categories: access to care, the care process, administrative efficiency, health outcomes and equity. (One bright spot – the US did rank second in the “care process” category.)
“No other country in the world expects patients and families to pay as much out of pocket for essential health care as they do in the US,” said Dr. Joseph Betancourt, president of The Commonwealth Fund.
What’s next: US residents expect presidential candidates to make health care a top priority as election season progresses. A Healthline analysis in October offered a side-by-side comparison of where Donald Trump and Kamala Harris stand on health care issues, from the Affordable Care Act to mental health services and prescription drugs.
What will the health workforce look like?
What happened: By the year 2028, the US is projected to be short 100,000 health care workers if current trends hold, a Mercer analysis found. Some states may actually have surpluses of employees, and others are likely to face deep deficits, researchers said. Demand for workers is estimated to reach 18.7 million by 2028, but the actual workforce will be around 18.6 million, and that shortfall is likely to tax an already strained health care system.
New York, New Jersey, Tennessee, Massachusetts and Georgia are projected to have the greatest deficits of health care workers by 2028. The states where surpluses are expected include California, Pennsylvania, Texas, Minnesota and Washington.
What’s next: There’s an interesting related trend taking place in US health care employment – the proportion of women employed by the sector has been rising steadily for decades, and they now account for nearly 70% of its workforce. An Axios analysis from late September sheds light on where the numbers are headed. It’ll be interesting to see if more women entering the job market translates into narrower staffing gaps.
What’s in store for post-pandemic public health?
What happened: According to a KFF report, public health officials had expressed concern that a “boom and bust” funding and staffing cycle was underway with the end of the COVID-19 crisis as pandemic aid dried up and federal grant funding ended. Their predictions have taken shape, local health departments’ budgets are seeing cuts, and jobs are going by the wayside – particularly affecting care for vulnerable populations like those in rural areas.
A National Association of County and City Health Officials report showed that local health department staffs expanded by 19% from 2019 to 2022. Since that time, officials in states like California, Montana and Washington have faced new budget and staff cuts. Public health experts have warned that resulting reductions in services could be serious enough to create crisis situations for US communities.
What’s next: NACCHO executive Adriane Casalotti noted that health department budget cutting and layoffs are likely to continue, especially as officials revisit health issues like suicide, substance use and sexually transmitted infections that slid to the back burner during the pandemic. Casalotti said rural health departments should receive more attention and funding than they do, as they are more deeply affected by hospital closures and vanishing services like maternity care.
Where will pregnant patients get care?
What happened: A March of Dimes analysis found that 1 of 3 three US counties is without an obstetric clinician, posing serious issues for millions of residents who need maternity services. The report also found that many obstetrician/gynecologists and family practitioners who deliver babies are departing the workforce, and hospital obstetric unit closures and abortion bans are making the situation worse. The American College of Obstetricians and Gynecologists has said a shortage of 12,000 to 15,000 OB/GYNs is likely by the year 2050.
What’s next: US maternity care access will “steadily become a more dire situation,” ACOG President Dr. Stella Dantas noted. Dantas said the organization is advocating for higher reimbursement and fewer administrative burdens for clinicians, better resources for rural practitioners, and policies on training other health professionals to handle obstetric cases and emergencies.
A March of Dimes map highlights current US maternity care deserts.
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